For the third consecutive year, HHS' Million Hearts initiative(millionhearts.hhs.gov) has selected a group of physicians and practices as its Hypertension Control Challenge Champions.(millionhearts.hhs.gov) And, as the number of recipients jumped from nine in 2013 to 30 in 2014, family physicians accounted for 60 percent of those chosen.
(Left to right) Laken Barkowski, R.N.; family physician Michael Rakotz, M.D.; and Jane Drage, M.A., work in concert to control their hypertensive patients' blood pressure.
"This year, we have more champions than ever before, demonstrating that high performance is achievable and that we are on a path to better heart health across the nation," said HHS Secretary Sylvia Burwell, in a news release.(www.cdc.gov) "More and more practices are using evidence-based strategies to help patients keep blood pressure down -- a strong sign that we're making progress in preventing heart attacks and strokes."
This year's Hypertension Control Champions are drawn from a wide range of settings, from private solo practices and tribal medical clinics to large health systems in both urban and rural areas. Together, they care for more than 3.5 million adult patients in 19 states, according to the news release.
HHS launched the Million Hearts initiative in 2011 with the goal of preventing 1 million heart attacks and strokes by 2017 by bringing together communities, health systems, nonprofit organizations, federal agencies and private-sector partners from across the country. The CDC and CMS co-lead the initiative.
Champions Utilize Patient Data
To be eligible, prospective entrants shared verifiable blood pressure control data and highlighted successful strategies or best practices adopted by the practice or system, such as the use of health information technology or team-based care.
- HHS has announced its Hypertension Control Challenge Champions for 2014, and family physicians accounted for 60 percent of those chosen.
- The champions achieved hypertension control rates ranging from 70 percent to more than 90 percent by using a variety of proven approaches.
- To be eligible for the challenge, prospective entrants shared verifiable high blood pressure control data and highlighted successful strategies or best practices adopted by the practice or system, such as the use of health information technology or team-based care.
The 2014 champions achieved control rates ranging from 70 percent to more than 90 percent using a variety of proven approaches, according to the news release. These approaches included
- making high blood pressure control a priority at every visit;
- using evidence-based guidelines;
- designating hypertension champions within a practice or organization;
- using team-based care models to increase contact with patients;
- implementing consistent, strategic use of health information technology -- including electronic health records (EHRs) -- that may incorporate clinical decision support tools, patient reminders and registry functionality;
- staying engaged with patients by offering free blood pressure checks, in-home nurse visits and medication checks by pharmacists; and
- publicly recognizing or using financial incentives to reward high-performing clinicians or teams.
FP Recipients Explain Their Success
One of the 18 family physicians and family medicine practices deemed champions is Michael Rakotz, M.D., of the Northwestern Medical Group in Chicago. He told AAFP News that his practice uses a team approach and standardized protocols to ensure all patients have their blood pressure measured accurately at every visit.
Physicians in the practice also are encouraged to promote self-measured blood pressure monitoring, also known as home blood pressure monitoring, to patients whenever possible. And patients are asked to return to the clinic every few weeks until their blood pressure is under control, Rakotz said.
"We also partner with our patients and their families whenever possible to encourage them to initiate small changes -- we call them 'micro changes' -- in their lifestyle so they can work slowly towards improving their health over time (diet, physical activity and weight loss)," he said. "In making changes this way, they are more likely to be sustainable changes."
Rakotz emphasized that being good at managing any chronic condition requires a team.
"My clinical team included two medical assistants, a registered nurse and three physicians working together with three front-office staff and a practice manager."
(Standing left to right) DeAnn Bell, M.A.; June Smith, A.P.R.N.; Reginald Parker, M.D.; Shelda Richardson; Timothy Buchanan; Karen McGrady; Lynne Jobes, M.A.; (seated left to right) Sonya Arrington; and Rachel Martin keep things ticking along at Northlake Family Medical Practice in Columbia, S.C.
Reginald Parker, M.D., of the Northlake Family Medical Practice in Columbia, S.C., told AAFP News that his practice has been incorporating all of the Healthcare Effectiveness Data and Information Set (HEDIS)(www.ncqa.org) measures into each patient the group sees.
"By following these guidelines, we can treat our patients appropriately," he said. "We have been doing these things for many years. But with the advances with EHRs, it has become easier to make sure each of them is documented. By incorporating all of the measures directly into our master set of ICD codes, our medical assistants who start the notes can verify our compliance before I ever see the patient."
Parker said he thinks it's important for physicians to approach treating a patient, including managing their hypertension, by evaluating what is going on physically, mentally, emotionally and financially.
"My patients know that we care about their health, but they also know we care about their overall well-being," he said. "If I prescribe a medication for hypertension, I have to know that they can afford that medication. Are they able to put food on their table and keep a roof over their heads? Why prescribe something if I know they are not going to be able to afford it and remain compliant?"
As for preventive measures, Parker said his practice recommends that hypertensive patients consider following the DASH (Dietary Approaches to Stop Hypertension) diet, as well as lowering salt intake and caffeine use.
Family Health Centers of San Diego also was named a Hypertension Control Champion, and Charles "Bart" Smoot, M.D., helped lead the staff's effort. He told AAFP News that the team uses a variety of health IT and traditional complementary methods to engage patients, as well as health care professionals.
"Using EHR and HEDIS guidelines, a hypertensive dataset was created that included all patients with an encounter (qualified visit to the health center) with a diagnosis of hypertension during the measurement year," Smoot said.
EHR dashboards were implemented at the facility, providing up-to-date performance results that physicians, physician assistants and nurse practitioners could access in real time to identify whether their patients were meeting specific clinical goals, including those related to hypertension.
Other tools also were included in the EHR, which clinicians used in treatment rooms during patient visits. "For example, hypertensive order sets and decision aid tabs allow providers to see deficiencies in metrics in one place without having to look through the entire record for historical data," Smoot said.
Providers who were noted to be significantly lower performers for the hypertension metrics were given individualized onsite training by IT and medical leaders to encourage improved performance and address EHR use deficiencies. Also, physicians were provided with quarterly data updates (e.g., a provider scorecard) on all patients they cared for (even if other providers had cared for the same patients) through quarterly meetings and internal newsletters, as well through the EHR dashboard.
"We also used the dataset to identify patients who had not received a medical examination within the prior six months, had no upcoming appointment and did not have adequately controlled blood pressure," Smoot said.
Those patients received:
- a customized letter in March 2014 that included their last blood pressure measurement, a warning that "high blood pressure is known as the silent killer" and encouragement to "please make an appointment within two weeks"; and
- an interactive voice response call (i.e., robocall) that included a social-norms marketing script reminding patients to "join the healthy majority by making an appointment today" and a warning that "uncontrolled high blood pressure can cause strokes, heart attacks and kidney disease."
"We were particularly surprised by the relatively large response we got from the targeted letter," Smoot said. "By including health-specific information such as their last blood pressure in the letter and the risks of uncontrolled blood pressure on their health, a significant number of these patients who had been lost to the clinic were back in for further care within a month of receiving it."
Finally, at Family Health Centers of San Diego, incentives were offered on a quarterly basis to all clinicians who met the health center target of having 65 percent of their hypertensive patients achieve blood pressure control.
The other family physician Hypertension Control Challenge Champions are:
- Colorado Springs Health Partners in Colorado Springs, Colo.;
- East Jordan Family Health Center in East Jordan, Mich.;
- Essentia Health in Duluth, Minn.;
- Brett Gray, M.D., of Cherokee Nation Health Services in Salina, Okla.;
- Kaiser Permanente, Southern California in Pasadena, Calif.;
- Kelsey-Seybold Clinic - Cypress in Houston;
- Kelsey-Seybold Clinic - Pasadena in Pasadena, Texas;
- Lexington Family Practice in Lexington, S.C.;
- Methodist Primary Care Group in Memphis;
- P.S. Rudie Medical Clinic in Duluth, Minn.;
- Premier Medical Associates in Monroeville, Pa.;
- Presbyterian Healthcare Services in Albuquerque, N.M.;
- Roane County Family Health Care in Spencer, W.Va.;
- Upper Valley Family Care in Troy and Piqua, Ohio; and
- WinMed Health Services in Cincinnati.
A full list of winners is available on the Hypertension Control Challenge Champions website(millionhearts.hhs.gov).
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